Adequacy of Nutrient Intakes of Severely and Acutely Malnourished Children Treated with Different Doses of Ready-To-Use Therapeutic Food in Burkina Faso

Abstract

Background Ready-to-use therapeutic foods (RUTF) are designed to cover the daily nutrient requirements of children with severe acute malnutrition (SAM). However, with the transfer of uncomplicated SAM care from the hospital environment to the community level, children will be able to consume complementary and family foods (CFF) in addition to RUTF, and this might decrease the quantity of RUTF needed for recovery. Objectives Using an individually randomized clinical trial, we investigated the effects of a reduced RUTF dose on the daily energy and macronutrient intakes, the proportion of energy coming from CFF, and the mean probability of adequacy (MPA) of intake in 11 micronutrients of 516 children aged 6–59 mo who were treated for SAM in Burkina Faso. Methods The data were collected using a single 24-h multipass dietary recall, 1 mo after starting treatment, from December 2016 to August 2018, repeated on a subsample of 66 children. Differences between children receiving the reduced RUTF (intervention arm) and those receiving standard RUTF (control arm) were assessed by linear mixed models. Results Daily energy intake was lower (P < 0.01) in the intervention arm (mean ± SD 1321 ± 339 kcal) than in the control arm (1467 ± 319 kcal). CFF contributed to 40% of the daily energy intake in the intervention and 35% in the control arm. The MPA for 11 micronutrients was 0.89 ± 0.1 in the intervention arm and 0.95 ± 0.07 in the control arm (P = 0.06). Conclusions Reducing the dose of RUTF during SAM treatment had a negative impact on daily energy intake of the children. Despite this, children covered their recommended energy intake. The energy intake coming from CFF was similar between arms, suggesting that children's feeding practices did not change due to the reduction in RUTF in this context. This trial was registered at the IRSCTN registry as ISRCTN50039021.

Complementary feeding practices and associated factors of dietary diversity among uncomplicated severe acute malnourished children aged 6–23 months in Burkina Faso

“…This finding is consistent with our previous finding that indicated no difference in energy intake from complementary and family foods between the study groups (Nikièma et al, 2021). in Niger context with RUTF (Madzorera et al, 2018) and nonmalnourished children in Burkina Faso context (Cliffer et al, 2020;MS, 2018).…”

“…The main results from the trial show that a reduced RUTF dose is non‐inferior to standard RUTF dose in terms of the weight gain velocity (g/kg/d) of children during treatment and results in similar recovery per cent (Kangas et al, 2019). In addition, similar levels of energy and nutrient intakes coming from complementary and family feeding in both RUTF groups were shown (Nikièma et al, 2021), which suggest that the two groups of children could have comparable dietary diversity. The present sub‐study aims to assess the complementary feeding practices of infants with SAM, aged 6–23 months, treated with different doses of RUTF, in the health district of Fada N'Gourma, and determine the factors associated with DDS.…”

“…The MANGO study has been described in detail elsewhere (Kangas et al, 2019; Nikièma et al, 2021). In short, it was a randomized controlled non‐inferiority trial conducted in the health district of Fada N'Gourma, eastern region of Burkina Faso.…”

“…Data collection took place 1 month after the admission of the children to treatment, on a total of 459 children aged 6-23 months (57% of MANGO main study sample). The sample for dietary intake was previously described (Nikièma et al, 2021). Complementary foods practice data were collected during Week 4 or 5 of treatment.…”

“…Ready‐to‐use therapeutic foods (RUTFs) are the only foods prescribed for nutritional recovery during the treatment of SAM in children (WHO, 2013; WHO et al, 2007), and the recommendation is to give no other foods than RUTF and breastmilk to these children (WHO et al, 2007). We have previously reported that children treated for SAM with RUTF supplement their diet with complementary and family foods (Nikièma et al, 2021).…”